Basic Information
| Provider Information | |||||||||
| NPI: | 1780053330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIPKIN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | WILLIAMS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 370 OAKPARK TERRANCE | ||||||||
| Address2: | |||||||||
| City: | MCDONOUGH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703010858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1740 HUDSON BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302816331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786041053 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2015 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 209616 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.